Dying to be Thin: Teenage Eating Disorders

Symptoms, causes and what can be done about them.

Your daughter seems to be losing too much weight lately. She has become more finicky about food and hardly eats in your presence. She claims she is not hungry or feels "too full," when you know she has not eaten all day. Just as she appears to be going overboard with her dieting, she is also exercising excessively.

Could your daughter be suffering from an eating disorder? What is an eating disorder and what are the symptoms? If your child does have an eating disorder, what caused it, what are the treatment options and how can you help her?

WHAT ARE EATING DISORDERS?

Eating disorders are self-destructive patterns of behavior related to food. In all cases, there is a preoccupation with food, where the person is constantly thinking about dieting. With anorexia, for example, the intake of food may be controlled, severely limited and/or ritualized. Anorexics may be unwilling or unable to eat in another person's presence. They often complain of feeling full or bloated when they are, in fact, starving.

In all cases of eating disorders, the young person's body image is severely distorted.

Bulimia is characterized by alternating bouts of binge eating followed by purging, or induced vomiting. In some cases, laxatives are abused to reduce body weight. In all cases of eating disorders, the young person's body image is severely distorted. They see themselves as much heavier and unattractive than they are seen by others. And they strenuously resist efforts by others to correct those distortions.

Both anorexics and bulimics may exercise excessively in a desperate attempt to lose even more weight. They may work out for hours, engaging in strenuous aerobic exercises which they feel are necessary to eliminate excess body weight.

While there have been cases of children as young as seven or eight years old as well as middle aged adults diagnosed with eating disorders, the overwhelming majority of cases appear in the teenage years. And 95% of all those who suffer from eating disorders are female.

For the most part, those with eating disorders tend to be perfectionistic and highly self-critical. They suffer from low self-esteem and often lack confidence. They crave attention and approval from others and may even appear manipulative in their interpersonal relations. They are quite secretive about their eating habits and almost always deny they have a problem with food.

While eating disorders are very much a psychological problem, they have extremely serious medical consequences. The self-starvation of anorexics and the bingeing and purging of bulimics often so severely interfere with body functioning that menstruation often ceases. In addition, the drastic weight loss associated with eating disorders can lead to renal failure, heart attacks and even death.

WHAT CAUSES EATING DISORDERS?

Eating disorders are caused by a variety of factors. In any case, there may be one or more of the following contributing influences.

1. Media images. Even if your children do not watch television or go to the movies, they are exposed to clothing advertisements on billboards and in newspapers and magazines which glamorize thinness. The message conveyed by these images is that you cannot be socially accepted or successful unless you are as skinny as the models. For teenaged girls who may already feel insecure about their social standing and appearance, weight loss may rise to the level of urgent priority.

2. Abuse or molestation. When young children have been traumatized by physical abuse or molestation, they need professional help to prevent long-term psychological damage. If their parents were unaware of the trauma to the child or were unable, for any reason, to arrange for the necessary treatment, the child has a high risk of developing an eating disorder in adolescence.

3. Dysfunctional family dynamics. If children grow up in homes where there is considerable verbal abuse or high levels of conflict and hostility, regardless of whether the children are the targets or only the bystanders, they are at an increased risk of developing an eating disorder.

Teenagers who live in such dysfunctional homes often feel helpless to correct the problems which are clearly not under their control. By regulating their eating with an eating disorder, they are unconsciously attempting to exercise control in the one area of their lives, namely food, which is totally under their control. They may also be unconsciously attempting to unite their discordant parents by forcing them to focus their attention on the eating disorder, as illustrated by the following three case examples.

THE CASE OF ROBIN

Robin was the youngest child in her family. Her older sister set a standard that she felt she could never attain. The older sister was prettier, smarter and much more socially successful than Robin.

As if that was not bad enough, Robin's parents were quite critical and not very supportive or encouraging. Robin's mother was especially harsh in her disapproval of Robin's appearance, grades and friends.

By the time Robin entered high school, she was convinced that she could never please her parents. Seeing her older sister enjoy the approval Robin was yearning for made her own lack of affection from her parents all the more painful for Robin.

In order to soothe her wounded sense of self, Robin sought comfort in food. While she felt better temporarily, the extra weight she gained only prompted more disparaging remarks from her parents. Robin attempted to deal with that dilemma by inducing vomiting after her binge eating. This set the pattern for bulimia, which required gut-wrenching family therapy to finally resolve.

THE CASE OF HADASSAH

When Hadassah was twelve years old, her parents divorced. The divorce was uncontested and amicable. Her parents used one lawyer to file the papers and there were no adversarial court battles over custody. Her parents agreed to let Hadassah's mother have custody while her father enjoyed liberal visitation rights.

The divorce was triggered by the father's extramarital relationship, which continued following the breakup of the marriage. Hadassah's father was so preoccupied with this relationship that he hardly took advantage of his visitation rights with his daughter.

One year later, Hadassah's mother remarried and soon had more children with her new husband. Hadassah felt her mother showed much more attention to her new siblings and stepfather than to her. By the time Hadassah reached twelfth grade, she felt so overlooked and disregarded that she requested to move in with her father and his new wife.

At the same time, Hadassah was becoming somewhat rebellious and disrespectful towards both parents. Her clothing style and choice of friends reflected this new oppositional attitude. She moved back into her mother's home, but was clearly unhappy and resentful.

As the confrontations with her mother increased, Hadassah became more and more uncooperative and disobedient. Her grades also plummeted at school. It was then that her mother suggested that Hadassah might like to speak with a therapist.

Hadassah resisted at first, but finally relented. After a few weeks of individual sessions, the therapist invited Hadassah's mother in for a joint session. It was then that her mother first leaned what she already suspected, that Hadassah had become anorexic.

Individual therapy for Hadassah continued. Two hospitalizations and family therapy with both of Hadassah's parents were added. Hadassah's mother even entered her own personal therapy to gain more insight into her strained relationship with her daughter. It took a couple more years, but Hadassah's mother learned how to demonstrate her love for her daughter in the way that Hadassah needed, which resulted in Hadassah finally overcoming her eating disorder.

TREATMENT OPTIONS

Unfortunately, there is no single treatment option that has proven to cure eating disorders effectively. Consequently, it is often necessary to implement more than one of the following strategies:

1. Hospitalization. Because of the life-threatening nature of eating disorders, hospitalization is necessary at times. Aside from such emergencies, hospitalizations can also be useful as part of an in-patient treatment program designed specifically for patients with eating disorders. These programs are geared for teenagers and include nutritional education and retraining, as well as group and individual therapies.
2. Medical consultation. Although there is no medical treatment for eating disorders, it is often recommended for the young person to be monitored by a physician specializing in adolescent medicine. The purpose of this consultation is to help determine if and when hospitalization may be needed, as well as to treat any medical complications resulting from the eating disorder.
3. Individual psychotherapy. It is always helpful for the young person to have her own therapist who can help her work through the underlying emotional conflicts, distorted body image and unhealthy family relationships. Those with eating disorders tend to be secretive and mistrustful. Consequently, it is vital for them to have their own therapists in whom they can confide without fear of unwanted disclosure.
4. Family therapy. By the time a teenager has developed an eating disorder, her relationships with one or both parents have usually become strained. The best way to resolve these conflicts, build trust and reconcile the differences is with family therapy, in which the teenager is seen together with her parents.

HOW TO BE HELPFUL

Aside from making the necessary arrangements for treatment, there are a number of things you can do to help your child cope with and eventually overcome her eating disorder.

1. Do not discuss food. Although this condition is very much food related, it will not be cured by you encouraging your child to eat properly. Paradoxically, one of the best things you can do to help is to avoid initiating any conversations about food.

2. While arranging for treatment is important, it is equally, if not more, important to cooperate and participate fully with your child's doctors and therapists. If they give you guidelines and recommendations, follow them, even if you do not always agree. If they give you guidelines and recommendations, follow them, even if you do not always agree. If they request your attendance at family therapy sessions or group meetings, make every effort to attend. Your participation in your child's therapy demonstrates your concern for her welfare much more than anything else.

3. Whether in a therapy session or at home, try to accept your child's feelings without become defensive. You do not have to agree with all of your child's complaints against you. To be sure, some of them may be exaggerated or distorted. Nevertheless, your child may have developed an eating disorder as a result of feeling unheard or invalidated so it will be extremely therapeutic for you to listen as effectively as you can.

Encourage and even pull for your child to express suppressed feelings of resentment or disappointment towards you or any other member of the family. This may be difficult for you to listen to but it will greatly speed up your child's recovery.

* * *

It can be terrifying for you to see your beloved child imprisoned by the self-imposed and self-destructive regimen of an eating disorder. The serious consequences of this condition justify your high level of concern and worry. The good news, however, is that with proper treatment, considerable patience and ample time, eating disorders can be successfully overcome and your child can move on to a healthy marriage and family life of her own.

The opinions expressed in the comment section are the personal views of the commenters. Comments are moderated, so please keep it civil.

Visitor Comments: 8

(8)
Bracha,
March 14, 2012 4:17 AM

Were all in this together!

I too have bulimia and anorexia and all i can say as a personal sufferer is that ittrying to fill empty voids by starving the soul, we somehow get a spiritual high. It is actually a proven thing, thats wht we fast on holy days because the brain actually gets a high ironically. Their are ways of dealing with emptiness other than threatening ones life! I am learning to pray and say tehilim or cry to god like a wounded child sobbing all my pain out instead of bottling it up and starving it... I hope this works!

(7)
Anonymous,
January 3, 2009 10:09 PM

Sisters

My sister has bulimia and it is very hard for the entire family to deal with. The hardest part for me was knowing that something was wrong, but not knowing what it was. Even when she eventually told me, she still wasn't completely open and I found out a lot through other sources. We used to be very close, but lately we haven't been spending a lot of time with each other. I'd like to encourage all parents who have a child with an eating disorder to be open with their other children about what is happening. A lot of the time the other children will find out information anyway, but it will be jumbled and confused. Most of the time it is the child with the eating disorder that people worry most about, but don't forget the other children, especially the ones who are close in age and have a special relationship with the patient. Good luck to all of those sisters out there. You'll be in my tefillos and please keep me and my sister in yours.

(6)
Anonymous,
March 29, 2006 12:00 AM

I know how they felt

I read this story because I am a recovering anorexic myself. I only had a vague idea on what caused it. But in your list of possible causes I had every one of them in my childhood. I was blessed because when I married my husband helped me battle it by having me make small but very important promises to him which began my steps toward recovery. I still forget to eat but it happens less and less, mainly only when I am stressed. There is a light at the end of the tunnel of eating disorders if the people who suffer from them find the love and acceptance that was missing at critical times in their lives. I was blessed, and I hope other people will be too.

(5)
sharon,
March 27, 2006 12:00 AM

another cause

Dr. Wikler left out one cause of eating disorders - the shidduch dating system. I know a number of lovely girls with terrific middos who are passed over, without even being met, because they are not supermodel thin.

(4)
Anonymous,
March 26, 2006 12:00 AM

also common in older women

I am almost sure that a family member of mine, who is over 50, has an eating disorder. She is obsessed with exersize, eats mostly only vegitables, and would NEVER eat a carb. She is all skin and bones.
I also think most Americans have issues with eating, even if its not to the extent of an eating disorder. The fad diets contribute to this, and most females I know can't enjoy a good meal without obsessing about what they ate or feeling guilty. Most people have such an extremely distorted image and even FEAR of food. Obviously some have weight problems and maybe for them diets are neccisary, but if the average person would eat when they were hungry and stop when satisfied, (even sometimes a treat when desired), they can maintain a normal, healthy weight- and be a much happier person. They won't feel such an urge to binge or starve themselves- food is available and can be a very enjoyable experience, but that's all it is- food. There is so much more to life.

(3)
guilda,
March 26, 2006 12:00 AM

I would like to know more about bulimia and how to deal with it (for my daughter)

I do not live in US, therefore, if you can help me to help my daughter who is bulimic and refuses to see doc. or phycotherapist. Please advise. I have been living with the problem for 7 years! Please help.

(2)
Josh Feder,
March 26, 2006 12:00 AM

Medical Treatment for Eating DIsorders

FYI to readers - there is a large body of medical research looking at the use of medications to help in the treatment of various eating disorders, including symptoms of binging and purging, obsessive thinking, anxiety, depression, and distorted thinking. When using medication, it is important to see a medical specialist who is trained in eating disorders. Although medication alone is not enough, it can make a significant difference for some people.

I've been striving to get more into spirituality. But it seems that every time I make some progress, I find myself slipping right back to where I started. I'm getting discouraged and feel like a failure. Can you help?

The Aish Rabbi Replies:

Spiritual slumps are a natural part of spiritual growth. There is a cycle that people go through when at times they feel closer to God and at times more distant. In the words of the Kabbalists, it is "two steps forward and one step back." So although you feel you are slipping, know that this is a natural process. The main thing is to look at your overall progress (over months or years) and be able to see how far you've come!

This is actually God's ingenious way of motivating us further. The sages compare this to teaching a baby how to walk. When the parent is holding on, the baby shrieks with delight and is under the illusion that he knows how to walk. Yet suddenly, when the parent lets go, the child panics, wobbles and may even fall.

At such times when we feel spiritually "down," that is often because God is letting go, giving us the great gift of independence. In some ways, these are the times when we can actually grow the most. For if we can move ourselves just a little bit forward, we truly acquire a level of sanctity that is ours forever.

Here is a practical tool to help pull you out of the doldrums. The Sefer HaChinuch speaks about a great principle in spiritual growth: "The external awakens the internal." This means that although we may not experience immediate feelings of closeness to God, eventually, by continuing to conduct ourselves in such a manner, this physical behavior will have an impact on our spiritual selves and will help us succeed. (A similar idea is discussed by psychologists who say: "Smile and you will feel happy.")

That is the power of Torah commandments. Even if we may not feel like giving charity or praying at this particular moment, by having a "mitzvah" obligation to do so, we are in a framework to become inspired. At that point we can infuse that act of charity or prayer with all the meaning and lift it can provide. But if we'd wait until being inspired, we might be waiting a very long time.

May the Almighty bless you with the clarity to see your progress, and may you do so with joy.

In 1940, a boatload 1,600 Jewish immigrants fleeing Hitler's ovens was denied entry into the port of Haifa; the British deported them to the island of Mauritius. At the time, the British had acceded to Arab demands and restricted Jewish immigration into Palestine. The urgent plight of European Jewry generated an "illegal" immigration movement, but the British were vigilant in denying entry. Some ships, such as the Struma, sunk and their hundreds of passengers killed.

If you seize too much, you are left with nothing. If you take less, you may retain it (Rosh Hashanah 4b).

Sometimes our appetites are insatiable; more accurately, we act as though they were insatiable. The Midrash states that a person may never be satisfied. "If he has one hundred, he wants two hundred. If he gets two hundred, he wants four hundred" (Koheles Rabbah 1:34). How often have we seen people whose insatiable desire for material wealth resulted in their losing everything, much like the gambler whose constant urge to win results in total loss.

People's bodies are finite, and their actual needs are limited. The endless pursuit for more wealth than they can use is nothing more than an elusive belief that they can live forever (Psalms 49:10).

The one part of us which is indeed infinite is our neshamah (soul), which, being of Divine origin, can crave and achieve infinity and eternity, and such craving is characteristic of spiritual growth.

How strange that we tend to give the body much more than it can possibly handle, and the neshamah so much less than it needs!